Dr Smith on the Rationale for Investigating the Predictive Utility of CA-125 KELIM Score in Ovarian Cancer

Gabriella Smith, MD, obstetrician/gynecologist, Cleveland Clinic, discusses the rationale for launching a retrospective study which evaluated the predictive value of CA-125 ELIMination Rate Constant K (KELIM) for survival outcomes with hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of surgery in epithelial ovarian cancer.

Smith and colleagues shared information from the study at the SGO 2024 Winter Meeting. In the study, the predictive value of KELIM score for progression-free survival (PFS) and overall survival (OS) outcomes was assessed in a specific cohort of patients undergoing neoadjuvant chemotherapy prior to interval debulking surgery, Smith begins. The study aimed to extend the understanding of the KELIM score's applicability in patients who underwent HIPEC during their interval debulking surgery. A particular focus was placed on individuals diagnosed with high-grade serous ovarian cancer, a subgroup in which the KELIM score has been previously validated, she explains. This retrospective study included 63 patients from the Cleveland Clinic's HIPEC database undergoing neoadjuvant chemotherapy followed by HIPEC and interval cytoreductive surgery between 2017 to 2022, Smith emphasizes.

Patients were required to have advanced high-grade serous ovarian cancer, and have had at least 3 CA-125 levels within 100 days of initiating neoadjuvant chemotherapy to accurately calculate the KELIM score, Smith says.

Patients without the requisite CA-125 data were excluded, along with patients with non-high-grade serous histology, and those who were lost to follow-up, she continues. Additional consideration was given to patients who were referred specifically for interval debulking and HIPEC but did not undergo neoadjuvant or adjuvant therapy at the Cleveland Clinic, as their follow-up data would not be accessible in the institutional database, she explains. Cox univariate and multivariate regression was employed to analyze collective data. However, the scarcity of events in the multivariate regression limited any meaningful interpretation of data, Smith states. Consequently, investigators primarily focused on data from the univariate analyses, shedding light on the association between the KELIM score, HIPEC, and the survival outcomes in the context of advanced high-grade serous ovarian cancer, she concludes.